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1. Assessment Information: Basic details including date of assessment, assessor name and qualifications, and location of assessment
2. Employee Information: Details of the employee whose workstation is being assessed, including job role and hours of DSE use
3. Workstation Identification: Specific details of the workstation being assessed including location and equipment inventory
4. Display Screen Equipment Assessment: Detailed evaluation of the display screen, including height, distance, reflections, and image quality
5. Workspace Assessment: Evaluation of the immediate workspace including desk, chair, and peripheral equipment
6. Environmental Factors: Assessment of lighting, noise, temperature, and humidity at the workstation
7. Work Patterns: Analysis of work routine, breaks, and task variation
8. Current Health Status: Documentation of any reported health issues or discomfort related to DSE use
9. Risk Assessment: Identification and evaluation of potential risks associated with the workstation
10. Recommendations: Specific actions required to address identified issues and improve workspace ergonomics
11. Compliance Statement: Declaration of compliance status with relevant Belgian and EU regulations
1. Previous Assessment Review: Review of previous assessments and actions taken - include when this is a follow-up assessment
2. Special Adaptations: Details of any special equipment or adaptations required for employees with specific needs or disabilities
3. Remote Working Considerations: Additional assessment factors for employees who work remotely - include for hybrid or remote workers
4. Training Requirements: Specific training needs identified during the assessment - include when training gaps are identified
5. Cost Implications: Estimated costs for recommended changes or equipment - include when significant modifications are needed
1. Appendix A - Workstation Photographs: Photographic evidence of the workstation setup and identified issues
2. Appendix B - Equipment Specifications: Technical specifications of current display screen equipment and furniture
3. Appendix C - Assessment Checklist: Detailed checklist used during the assessment process
4. Appendix D - Employee Questionnaire: Completed pre-assessment questionnaire from the employee
5. Appendix E - Reference Standards: Relevant Belgian and EU standards for display screen equipment
6. Schedule 1 - Action Plan: Detailed timeline and responsibilities for implementing recommendations
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